Contraception for adolescents: a growing need of today

The future of adolescent contraception requires the collaboration between providers, patients and sometimes their parents. Trends show that percentage of those with premarital sexual experience and adolescent pregnancy outside marriage in India are also on the rise making the situation worse and requiring urgent attention from policies and programmes. Teenage pregnancy prevention is a priority because of the implications for the patients as well as for the society as a whole. The ability to provide non-discriminatory, confidential, accessible care and our role in the education and guidance of our patients are likely to determine the future of this generation of teens

Analysis of still births in a tertiary care system and changed scenario over six year period

                       Background: In India, the maternal and infant mortality rates have been steadily decreasing in recent years, but there has been no corresponding decrease in the perinatal mortality. Hence, there is need to evaluate the factors leading to this unfortunate event. The objective of this study was to find out various factors (especially preventable) responsible for perinatal stillbirths.Methods: An analytical comparative study in a tertiary care hospital comparing fresh and macerated still births over a period of one year in 2011 and 2017 and responsible factors were analysed.Results: Amazingly, despite improvement in the antenatal services, more institutional deliveries, there is no change in the incidence of still birth rate. However, there was decrease in the rate of still births due to extreme prematurity and congenital malformations. There was no change in incidence of PIH/ Eclampsia, IUGR and placental causes but there was substantial increase in the incidence of GDM.Conclusions: Perinatal mortality can definitely be reduced by strengthening and improving quality of antenatal services, early identification of high risk pregnancies, timely referral and appropriate intervention

Vitamin D deficiency and maternal complications

Background: Vitamin D deficiency is prevalent in India, a finding that is unexpected in a tropical country with abundant sunshine. Vitamin D deficiency is recognized as the most untreated nutritional deficiency currently in the world. Several studies reported the relationship between maternal vitamin D deficiency and adverse maternal and fetal outcomes including gestational diabetes, preeclampsia, preterm labour, low birth weight and increased rate of caesarean section.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, Himachal Pradesh, India over a period of 12 months. Six hundred women were included in the study.Results: Forty-eight (8%) subjects developed preeclampsia-eclampsia syndrome, of which none had sufficient vitamin D levels, whereas 48 (100%) subjects had vitamin D deficiency.Conclusions: Maternal antenatal complications are more common in vitamin D deficient group

Vitamin D deficiency and adverse fetal outcome

Background: Vitamin D deficiency is recognized as the most untreated nutritional deficiency in the world. It is plausible that vitamin D deficiency could make the fetal heart more vulnerable to distress/birth asphyxia. Vitamin D deficiency has been hypothesized to be associated with low birth weight, low Apgar score at birth, higher rates of still births and admission to NICU. The aim of present study was to study prevalence of vitamin D deficiency in pregnancy and evaluate perinatal outcome.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, India over a period of 12 months. Six hundred women were included in the study.Results: All the mothers who had still births suffered from vitamin D deficiency and the severe vitamin D deficiency was there in 90.91% (30) of these subjects. Severe vitamin D deficiency was seen in 78.95% (75) of the subjects having babies with birth weights <2.5 kg compared to 61.16% (288) subjects of the other group.Conclusions: Adverse fetal outcome are more common in vitamin D deficient group

Detection of spontaneous hemoperitoneum in a pregnancy complicated with endometriosis during caesarean section - a case report

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. During pregnancy endometriosis and its related pain symptoms improve due to various metabolic, hormonal, immune and angiogenesis changes that occur in pregnancy. Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but serious pregnancy complication, which is associated with high rates of maternal and foetal morbidity and mortality. Endometriosis may be a potential risk factor for SHiP. Preformation of IVF on women with endometriosis may be a potential risk factor for SHiP. In gravid females with a history of endometriosis, severe abdominal pain, and a reduction of haemoglobin, physicians should always suspect SHiP because it is a life-threatening condition for both the mother and the baby. We are reporting a case of a primigravida with term gestation, taken up for emergency caesarean section in view of non-reassuring foetal heart rate. Intraoperatively there was evidence of hemoperitoneum and multiple endometriotic lesions on the posterior surface of uterus and Pouch of Douglas, Bilateral ovaries were adherent to the endometriotic growth on the posterior surface of uterus. Postoperatively, patient was stable and was discharged on postoperative day 4

A comparative study on the effect of intravenous Ringer lactate at 125 ml/hour versus 250 ml/hour on the duration of labour in nulliparous pregnant women

Background: Several factors may influence the progression of normal labour. It has been postulated that the routine administration of intravenous fluids to keep women adequately hydrated during labour may reduce the period of contraction and relaxation of the uterine muscle, and may ultimately reduce the duration of the labour. However, the routine administration of intravenous fluids to labouring women has not been adequately studied although it is widely practiced, and there is no consensus on the type or volume of fluids that are required, or indeed, whether intravenous fluids are at all necessary. This study was conducted to study the effect of intravenous Ringer lactate at 125 ml/hour versus 250 ml/hour on the duration of labour. Methods: In the study, patients were divided in two groups of nulliparous pregnant women in spontaneous early labour (between 3-5 cm dilatation), at term with singleton pregnancy and cephalic presentation, where one group received intravenous Ringer lactate at 125 ml/hour and the other group received Ringer lactate at 250 ml/hour. The duration of labour, mode of delivery and caesarean rates were measured in both groups along with incidence of prolonged labour and need for oxytocin augmentation. Results: The incidence of prolonged labour and oxytocin augmentation were less in the group receiving intravenous RL at 250 ml/hour but was not statistically significant. Remaining outcomes were comparable in both the groups with no outcome reaching statistical significance. Conclusions: Rate of fluid administration is one of the many variables which affects the labour outcomes. The incidence of prolonged labour and oxytocin augmentation was less in the group which received intravenous RL 250 ml/hour. There was no statistically significant difference in both groups in respect of duration of labour, mode of delivery and caesarean rates

Transvaginal sonography versus saline contrast sonohysterography in evaluation of abnormal uterine bleeding

Background: To evaluate TVS and SCSH as a screening method in case of AUB and to correlate he findings of TVS and SCSH with hysterectomy specimen.Methods: Present study was conducted in department of obstetrics and gynaecology, Kamla Nehru Hospital for mother and child, IGMC, Shimla for a period of one year. A total of 150 patients with AUB were subjected to TVS and SCSH in same sitting irrespective of their phase of menstrual cycle. All the cases were subjected to hysterectomy within 2 weeks and operative findings were noted. Data was collected and findings analysed.Results: Overall sensitivity of SCSH was found to be 97.6% while that of TVS was 95.1%. The overall specificity of SCSH was found to be 99.6% and that of TVS was 98.2%. PPV, NPV and DA for SCSH was more than that of TVS i.e., 98.9% vs 97.4%, 99.7% vs 99.3% and 99.4% vs 98.7%.Conclusions: SCSH represents a new and promising technique for investigation of the uterine cavity. It is safe, minimally invasive, easy, cost effective and reliable method to diagnose the cause of AUB

Prevalence of vitamin D deficiency in antenatal women

Background: Vitamin D has an increasingly recognised repertoire of non-classical actions, such as promoting insulin action and secretion, immune modulation and lung development. It therefore has the potential to influence many factors in the developing fetus. Several studies reported the relationship between maternal vitamin D deficiency and adverse maternal and fetal outcomes including gestational diabetes, preeclampsia, preterm labour, low birth weight and increased rate of caesarean section. The present study was undertaken to study the prevalence of vitamin D deficiency in antenatal women of Shimla, India.Methods: The study was conducted in the department of Obstetrics and Gynaecology, Kamla Nehru Hospital, Shimla, India over a period of 12 months. Six hundred women were included in the study.Results: Out of 600 subjects, 568 (94.67%) subjects had vitamin D deficiency and only 32 (5.33%) subjects had sufficient vitamin D levels. Vitamin D deficiency was more common in the vegetarians, dark skinned subjects and in those who were taking vitamin D supplements.Conclusions: It is concluded from this study that there is high prevalence of vitamin D deficiency in antenatal women of Shimla, India

Role of micronized progesterone in prevention of preterm labour in women with previous history of one or more preterm births: a research study at a tertiary care hospital

Background: According to the WHO, 3 million newborns die each year due to complications related to pregnancy and childbirth and 99% of these deaths occur in the developing countries. Preterm birth is a leading cause of neonatal and infant mortality as well as short and long term disability. The mechanism responsible for preterm labour are not exactly known, may be multifactorial and preventable with timely and appropriate treatment.Methods: This was a prospective double blinded randomized placebo controlled study conducted in the department of Obstetrics and Gynaecology, Kamla Nehru State hospital for mother and child, Shimla. Total 80 patients with asymptomatic high risk singleton pregnancy between 24-28 weeks were included in the study. They were randomly allotted to receive either the progesterone tablet 100 mg intravaginally (Study group) or an identical looking placebo (Control group).Thus both the groups included 40 subjects each. The treatment was continued till 34 weeks of gestation or till PROM/ delivery, whichever was earlier. Method of termination, gestational age at time of delivery, mode and type of delivery, birth weight, apgar score, maternal and perinatal outcome were noted and compared in both groups. All the parameters were statistically analysed by mean + S.D, proportion, frequency, chi-square test. Percentage reduction in the quantitative variables was calculated using the formula of (n-t)/n x100.Results: The incidence of preterm deliveries in the present study was found to be 9.88%. Both the groups were comparable in respect of age, parity, BMI, socioeconomic status, occupation and gestational age at first antenatal visit. There was similarity in both groups in respect to number of previous preterm deliveries and cervical length. The incidence of preterm delivery in the study group was 12.5% and in the control group was 35%.Conclusions: The study concluded that progesterone use was associated with 64.2% reduction in the incidence of preterm delivery (p=0.029).Antenatal administration of progesterone reduces the risk of preterm birth before 37 weeks and 34 weeks as well as the risk of a newborn being born with a birth weight of less than 2500 gms

Inter-pregnancy interval and pregnancy outcome

Background: Obstetricians are often presented with questions regarding the optimal Inter-pregnancy interval (IPI), especially by women who had a spontaneous abortion. They often desire to conceive again with minimal delay.Methods: A study was conducted on 252, 2nd gravida women with history of previous spontaneous abortion. Based on their IPI women were divided into 5 groups.Results: Most of the pregnancy complications like threatened miscarriage, premature rupture of membranes (PROM), diabetes, pre-eclampsia, preterm delivery, placental abruption, caesarean section and post-partum hemorrhage (PPH) were maximum in those who conceived after 24 months and least in those who conceived between 6-12 months. But intra uterine growth restriction (IUGR) was more in early conception group. Pregnancy outcome was also good in those who conceived within 6 months.Conclusions: Women who conceive between 6-12 months of an initial miscarriage have better outcomes and lower complication rates in their subsequent pregnancy. Based on the results, we support the recommendation of WHO that after an abortion, women should wait for at least 6 months before becoming pregnant again in order to prevent adverse perinatal and maternal outcomes in the subsequent pregnancy. As the pregnancy outcome is also good in those who conceived within 6 months, women wanting to conceive immediately due to increasing age or anxiety should not be discouraged and allowed to conceive